We studied 29 children admitted to Beijing Children's Hospital (BCH) with acute flaccid paralysis between June 1991 and June 1993. Twenty-seven patients had Guillain-Barré syndrome--7 with acute inflammatory demyelinating polyneuropathy and 20 with acute motor axonal neuropathy (AMAN). Two had poliomyelitis. The most common cause of acute flaccid paralysis at BCH is the AMAN pattern of GBS.
Background: With the widespread application of regional low-flow perfusion (RLFP), development of surgical techniques, and shortened circulatory arrest time, deep hypothermia is indispensable for organ protection. Clinicians have begun to increase the temperature to reduce hypothermia-related adverse outcomes. The aim of this study was to evaluate the safety and efficacy of elevated temperatures during aortic arch surgery with lower body circulatory arrest (LBCA) combined with RLFP.Methods: We retrospectively analyzed data from 207 consecutive pediatric patients who underwent aortic arch repair with LBCA & RLFP between January 2010 and July 2017 and evaluated different hypothermia management strategies. The overall cohort was divided into three groups: deep hypothermia (DH, 20.0–25.0°C), moderate hypothermia (MoH, 25.1–30.0°C) and mild hypothermia (MH, 30.1–34.0°C).Results: The percentage of AKI-1 occurrences was significantly increased in the MH group (51.52%) compared to those in the DH (25.40%) and MoH (37.84%) groups (P = 0.036); prolonged hospital stay occurrences were decreased with elevated temperature (DH 47.62%, MoH 28.83%, MH 18.18%, P = 0.006). Neurological complications, peritoneal dialysis, hepatic dysfunction, 30-day hospital mortality, delay extubation occurrences were no significant among the groups. Logistic analysis showed that the MH group was negatively associated with post-op AKI-1 compared with the DH group [OR = 0.329 (0.137–0.788), P = 0.013], no differences were found between the MoH and the MH group. Compared to other groups, the intubation time (P = 0.006) and postoperative hospital stay (P = 0.009) were significantly decreased in the MH group. Multivariate logistic analysis showed hypothermia levels were not significant with prolonged hospital stay.Conclusions: This retrospective analysis demonstrated that for pediatric patients undergoing surgeries with RLFP & LBCA, three different gradient temperature management strategies are available: deep, moderate, and mild hypothermia. Utilizing mild or moderate hypothermia is safe and feasible. Although the number of AKI-1 occurrences in the MH group was significantly increased compared to those in the other groups, further analysis showed no significance in the MoH and MH group, mild hypothermia management is as safe as others when used appropriately.
Background:Antegrade selective cerebral perfusion (ASCP) is regarded to perform cerebral protection during the thoracic aorta surgery as an adjunctive technique to deep hypothermic circulatory arrest (DHCA). However, brain metabolism profile after ASCP has not been systematically investigated by metabolomics technology.Methods:To clarify the metabolomics profiling of ASCP, 12 New Zealand white rabbits were randomly assigned into 60 min DHCA with (DHCA+ASCP [DA] group, n = 6) and without (DHCA [D] group, n = 6) ASCP according to the random number table. ASCP was conducted by cannulation on the right subclavian artery and cross-clamping of the innominate artery. Rabbits were sacrificed 60 min after weaning off cardiopulmonary bypass. The metabolic features of the cerebral cortex were analyzed by a nontargeted metabolic profiling strategy based on gas chromatography-mass spectrometry. Variable importance projection values exceeding 1.0 were selected as potentially changed metabolites, and then Student's t-test was applied to test for statistical significance between the two groups.Results:Metabolic profiling of brain was distinctive significantly between the two groups (Q2Y = 0.88 for partial least squares-DA model). In comparing to group D, 62 definable metabolites were varied significantly after ASCP, which were mainly related to amino acid metabolism, carbohydrate metabolism, and lipid metabolism. Kyoto Encyclopedia of Genes and Genomes analysis revealed that metabolic pathways after DHCA with ASCP were mainly involved in the activated glycolytic pathway, subdued anaerobic metabolism, and oxidative stress. In addition, L-kynurenine (P = 0.0019), 5-methoxyindole-3-acetic acid (P = 0.0499), and 5-hydroxyindole-3-acetic acid (P = 0.0495) in tryptophan metabolism pathways were decreased, and citrulline (P = 0.0158) in urea cycle was increased in group DA comparing to group D.Conclusions:The present study applied metabolomics analysis to identify the cerebral metabolic profiling in rabbits with ASCP, and the results may shed new lights that cerebral metabolism is better preserved by ASCP compared with DHCA alone.
By using cannulation of the subclavian artery rather than the aorta and with a low priming volume, we established a modified rabbit model of ASCP with cardioplegic arrest. The model has excellent repeatability and operability, which is similar to the clinic process and is suitable for the study of cerebral, cardiac and renal protection.
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